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What Every Woman Should Know About Female Sterilization

What is female sterilization?

Highlights

  1. There are two main types of female sterilization: surgical (called tubal ligation) and nonsurgical.
  2. Tubal ligation prevents pregnancy immediately after the procedure, while nonsurgical sterilization may take up to three months to be effective.
  3. Side effects and complications are rare but may include infection, bleeding, and ectopic pregnancy.

Female sterilization is a permanent procedure to prevent pregnancy. It works by blocking the fallopian tubes. When women choose not to have children, sterilization can be a good option. It’s a slightly more complex and expensive procedure than male sterilization (vasectomy).

According to a survey from the Centers for Disease Control and Prevention, approximately 27 percent of American women of reproductive age use female sterilization as their form of birth control. This is equivalent to 10.2 million women. This survey also found that black women were more likely to use female sterilization (37 percent) than white women (24 percent) and U.S.-born Hispanic women (27 percent).

Female sterilization is most common in developing countries. Women ages 40–44 years are more likely than all other age groups to use female sterilization, with 51 percent choosing it as their primary birth control method.

There are two main types of female sterilization: surgical and nonsurgical.

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Types

What’s the difference between surgical and nonsurgical sterilization?

The surgical procedure is tubal ligation, in which the fallopian tubes are cut or sealed. It’s sometimes referred to as getting your tubes tied. The procedure is usually performed using a minimally invasive surgery called laparoscopy. It can also be done just after a vaginal delivery or cesarean section.

Nonsurgical procedures use devices placed in the fallopian tubes to seal them. The devices are inserted through the vagina and uterus, and the placement doesn’t require an incision.

Effects

How does female sterilization work?

Sterilization blocks or seals the fallopian tubes. This prevents the egg from reaching the uterus and also keeps the sperm from reaching the egg. Without fertilization of the egg, pregnancy can’t occur.

Tubal ligation is effective immediately after the procedure. Nonsurgical sterilization may take up to three months to be effective as the scar tissue forms. Results for both procedures are typically permanent with small risk of failure.

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Administration

How is female sterilization performed?

A doctor must perform your sterilization. Depending on the procedure, it can be performed in a doctor’s office or hospital.

Tubal ligation

For a tubal ligation, you will need anesthesia. Your doctor will inflate your abdomen with gas and make a small incision to access your reproductive organs with the laparoscope. Then they will seal your fallopian tubes. The doctor may do this by:

  • cutting and folding the tubes
  • removing sections of the tubes
  • blocking the tubes with bands or clips

Some sterilization procedures require only one instrument and incision, while others require two. Discuss the specific procedure with your doctor in advance.

Nonsurgical sterilization

Currently one device is used for nonsurgical female sterilization. It’s sold under the brand name Essure and is sometimes called fallopian tube occlusion. It consists of two tiny metal coils. One is inserted into each fallopian tube through the vagina and cervix. Eventually, scar tissue forms around the coils and blocks the tubes.

No incisions are necessary, so recovery times may be faster than with surgery. The procedure can be done in a physician’s office using local anesthesia and sedation. It can also be done under general anesthesia in a hospital or surgical center if you require more analgesia.

Nonsurgical sterilization is not effective right away. It takes time for the scar tissue to form and block your fallopian tubes. You will need to return to your doctor after some time to see if the procedure was effective. A special type of X-ray called a hysterosalpingography uses dye to show if your tubes are open.

Recovery

Recovery from female sterilization

After the procedure, you’ll be monitored every fifteen minutes for an hour to make sure that you’re recovering and that there are no complications. Most people will be discharged that same day, normally within two hours.

Recovery usually takes between two and five days. Your doctor will likely ask you to return for a follow-up appointment one week after the procedure.

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Effectiveness

How effective is female sterilization?

Female sterilization is nearly 100 percent effective in preventing pregnancy. According to one study, approximately 2–10 out of 1,000 women might get pregnant after tubal ligation. Another study, published in Contraception, found that 24–30 women out of 1,000 got pregnant after tubal ligation.

Nonsurgical sterilization is also highly effective, though some studies have found that it’s slightly less effective than surgical sterilization, especially in the first year. The Contraception study above found that 96 out of every 1,000 women got pregnant after using Essure. Implant procedures take up to three months to be effective, which may explain the slightly lower rate of effectiveness. In the meantime, another method of birth control is necessary to prevent pregnancy.

Cost of Tubal Ligation

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Benefits

What are the benefits of female sterilization?

Female sterilization is a good option for women who want effective and permanent birth control. It’s safe for almost all women and has an extremely low failure rate. Sterilization is effective without leading to the same side effects as other methods, such as birth control pills, the implant, or even the intrauterine device (IUD). For example, the procedure does not affect your hormones, menstruation, or sexual desire.

Some evidence also suggests that female sterilization may slightly reduce the risk of ovarian cancer.

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Disadvantages

What are the disadvantages of female sterilization?

Because it’s permanent, female sterilization is not a good option for women who may want to get pregnant in the future. Some tubal ligations may be reversible, but reversals often don’t work. Women should not count on the possibility of a reversal. And nonsurgical sterilization is never reversible.

If there is any chance you may want a child in the future, sterilization is probably not right for you. Talk to your doctor about other options. An IUD may be a better choice. It can be left in place for up to 10 years, and removal of the IUD restores your fertility.

Learn more about IUDs »

Unlike some other methods of birth control, female sterilization does not help women who want or need to manage menstrual cycle problems. Female sterilization does not protect against sexually transmitted infections (STIs), either.

Some women may have extra factors to keep in mind when considering female sterilization. For example, women who are at high risk for negative reactions to anesthesia may not be able to undergo a surgical procedure. For women who want to undergo nonsurgical sterilization, there are other restrictions. At the moment, nonsurgical sterilization isn’t an option for people who:

  • have only one fallopian tube
  • have had one or both fallopian tubes obstructed or closed
  • are allergic to contrast dye used during X-rays

Risks

What are the risks of female sterilization?

There are certain risks involved in any medical procedure. Infection and bleeding are rare side effects of tubal ligation. Talk to your doctor about the risks before the procedure.

For sterilization using inserts, there is a small chance that the implants could become dislodged or damage the uterus. In clinical studies, most women reported little to no pain. However, some reports of long-term chronic pelvic pain in women may be related to Essure. In 2016, the Food and Drug Administration (FDA) ordered Essure to make changes to its packaging. A boxed warning is now required along with a checklist of potential risks and benefits. The FDA has also mandated that Essure conduct a clinical study to evaluate the risks among particular women. These studies have not yet been published.

In rare cases, the tubes can spontaneously heal after sterilization. According to Planned Parenthood, if this occurs, there is a one-in-three chance that any pregnancy occurring after sterilization will be ectopic. An ectopic pregnancy occurs when the fetus implants in the fallopian tube instead of the uterus. It’s a potentially very serious medical problem. If not caught in time, it can be life-threatening.

Learn more: Ectopic pregnancy »

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Female sterilization vs. vasectomies

Female sterilization vs. vasectomies

Vasectomies are permanent sterilization procedures for men. They work by tying, clipping, cutting, or sealing the vas deferens to prevent the release of sperm. The procedure may or may not require small incisions and local anesthesia.

A vasectomy typically takes between two and four months to become effective after the procedure. After one year, it’s slightly more effective than female sterilization. Like female sterilization, a vasectomy does not protect against STIs.

Couples who choose to opt for a vasectomy may do so because:

  • it’s typically more affordable
  • it’s considered a safer and, in some cases, less invasive procedure
  • it doesn’t raise the risk of ectopic pregnancy

On the other hand, couples who opt for female sterilization may do so because tubal ligation is effective immediately, while vasectomies may take a few months to be effective.

Outlook

Outlook

Make an appointment with your doctor to discuss female sterilization and determine if it is the best birth control option for you. If you opt for nonsurgical sterilization, you’ll need to use another method of birth control for three months after the procedure. You will still have your period and you will not experience a drop in libido.

No lifestyle changes are necessary with female sterilization. It’s important to remember that while female sterilization prevents pregnancy, it does not protect against STIs. If you need STI protection, use condoms.

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